By Michael Jordan, MD

In this month’s issue of the journal Pediatrics a provocative question was presented; “Should school boards discontinue support for high school football?”

Four different experts contributed their view to this question which was raised because of the risk of injury. Indeed one of the experts presented data and an opinion that he believed it is unethical for pediatricians to support, and for school boards to approve and finance high school football programs. The opinion of the other three doctors did not go as far as to recommend discontinuation of football, but all raised the concern and uncertainty on the extent that concussion may play in the future mental health and development of young high school football athletes.

A concussion is a traumatic brain injury, caused by a blow to the head or a sudden acceleration/deceleration event. Imagine a brain, the constituency of firm Jello within a closed shell. If an impact causes the moving skull, with its soft contents, to suddenly come to a rotating stop, even with a well fitted helmet the brain of the player continues forward until impact against the internal wall of the skull. The shock wave from that internal deceleration can suddenly, “turn out the lights” – like an electrical surge through your computer. The lights may slowly flicker back on, but the event causes symptoms and sometimes significant impairment. If a second concussion occurs before the symptoms of the first one have passed, permanent dangerous changes, even death, can occur. Most concussion symptoms begin immediately or in a short while after injury, with headache, or nausea, sometimes dizziness, feeling foggy and often confusion and difficulty concentration which may last weeks or longer.

In the USA, approximately 1.1 million boys play high school tackle football. Of those, concussions occur frequently enough that one high school player in 14 will have one. High school football leads the list of sports with the highest risk but in college sports the numbers are somewhat different with women’s ice hockey owning the highest rate, but still half the rate of high school football. The rate of concussion in college football being much less that high school football suggests that tackling skill and technique and neck muscle development may reduce the rate of concussion. Helmets have greatly reduced the number of skull fractures, but they don’t prevent concussion which is a deceleration injury and not always an impact injury.

The other difficulty we face in healthcare is that there is no really good test or x-ray study that confirms the diagnosis of concussion. We make that diagnosis by subjective assessments on the level of consciousness and cognitive function after head impact. The good news is that by far the great majority of student athletes who suffered a concussion gets better in about 3 weeks, and for those who have suffered a single concussion there does not appear to be long-term consequences.

I do not advocate discontinuing high school football, it is a risky sport but so are Ice hockey and soccer and lacrosse. I believe sports in school are so important that every student should take part in some sport during the school year. Sports challenge students to develop skills, a love for the sport and effective teamwork with a common goal. That can be good preparation for the kind of work they will likely due for the rest of their life.

There are number of ways in which football players can diminish decrease the risk of concussion; good coaching and proper technique, having trainers available at practice and games. All parents, coaches and schools should support referees when they enforce the rules which are in many ways meant minimize injury. We’ve recently found that helmet design can make a big difference and following the studies done at Virginia Tech the most common Riddell helmet was dramatically improved and the new design has been shown to reduce concussions so well it is now in extensive use in major college and NFL teams.

I recommend that schools encourage pre-participation checkups as well as individual neuro-cognitive baseline testing which can be then used as a comparison after injury. Here at Rochester Regional Health we have developed a concussion program with sports medicine experts who are working with the local school districts to decrease the risk of concussion as well as to manage the treatment of concussion in a scientific-evidence based approach. The sports medicine team can help manage a care plan customized to the student athlete with physical, vestibular, occupational and speech therapy delivering the best outcome following these serious injuries.
The bottom line is concussion intervention is that “when in doubt - sit them out.” The New York State Education Department and local school districts have all agree to a standardized return to play and return to learn protocol that should minimize the risk of long term complications from concussion. For further information and to access the Rochester Regional Health - Concussion Program, please go www.rochesterregional.org or call 585-922-1212.